Podcast 618: Treating Opiate Side Effects

<p><strong>Contributor: Don Stader, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Majority of patients experience side effects while taking opioids</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Most common include nausea/vomiting, puriitis, constipation; more severe and less common include respiratory depression, addiction and overdose</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Opiates can cause nausea, but ondansetron (Zofran) is the wrong treatment because it’s not antidopaminergic. Instead consider using metoclopramide (Reglan), olanzapine (Zyprexa), or haloperidol (Haldol)</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Itching from opiates isn’t histamine mediated so hydroxyzine (Atarax) and diphenhydramine (Benadryl) aren’t effective - oddly ondansetron may help with itching.</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Constipation is best treated with promotility agents like Senna, rather than stool softeners</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Rogers E, Mehta S, Shengelia R, Reid MC.</span> <a href= "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418642/"><span style="font-weight: 400;"> Four Strategies for Managing Opioid-Induced Side Effects in Older Adults</span></a><span style="font-weight: 400;">. Clin Geriatr. 2013 Apr;21(4):  PMID: 25949094; PMCID: PMC4418642.</span></span></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Farmer AD, Holt CB, Downes TJ, Ruggeri E, Del Vecchio S, De Giorgio R.</span> <a href= "https://www.thelancet.com/journals/langas/article/PIIS2468-1253(18)30008-6/fulltext"> <span style="font-weight: 400;">Pathophysiology, diagnosis, and management of opioid-induced constipation.</span></a> <span style= "font-weight: 400;">Lancet Gastroenterol Hepatol. 2018 Mar;3(3):203-212. doi: 1